Patricide and schizophrenia – A case report Comments about letter to the editor

The case report “Patricide and Schizophrenia”¹ is very interesting and the topic highly relevant, once violence among psychiatric patients is quite a taboo, surrounded by prejudice, on the one hand, and misinformation on the other hand.

In the first place, it is noteworthy that psychiatric patients are more prone to be victim than perpetrator of crime and violence². Thus, the main reason why people associate mental illness with aggressiveness is, above all, due to stigma and prejudice.

Nevertheless, one can not deny that severe psychotic patients, especially without proper treatment, are at a slightly but significantly higher risk of turning violent³. The risk is even higher when there is a comorbid abuse of substances³.

Killing the own father is a rare crime, but one that highly concerns psychiatrists. Whereas it is usually linked to a kind of family violence revenge if conducted by adolescents⁴, it is, if committed by an adult, often a case that involves a psychiatric patient, frequently suffering from schizophrenia⁵. Thus, this specific kind of homicide is, at least partially, a crime that could be prevented: if psychotic patients receive proper treatment, the symptoms can be controlled and, undoubtedly, a significant number of those crimes could be avoided.

References

• ¹
  Moscatello R. Patricide and schizophrenia – A case report. Arch Clin Psychiatry. 2014;41(6):159.
• ²
  Teplin LA, McClelland GM, Abram KM, Weiner DA. Crime victimization in adults with severe mental illness: comparison with the National Crime Victimization Survey. Arch Gen Psychiat. 2005;62(8):911-2.
• ³
  Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):487-503.
• ⁴
  Newhill CE. Parricide. J Fam Violence. 1991;6(4):375-94.
• ⁵
  Weisman AM, Sharma KK. Forensic analysis and psycholegal implications of parricide and attempted parricide. J Forensic Sci. 1997;42(6):1107-13.

SCIMAGO INSTITUTIONS RANKINGS

The crime of parricide, as well as other violent acts, are not always associated with mental disorders. When this correlation exists, it is mainly associated with psychotic disorders.

Among the major psychotic syndromes, schizophrenia is considered the most important, both for the prevalence and chronicity of symptoms. Other psychotic syndromes, such as persistent delusional disorders and transiate psychotic disorders have a lower association with violent crimes, even though their prevalence in the general population are relevant.

The most recent psychiatric classifications tend to group diagnoses into broad categories. These groups aim to increase reliability among psychiatrists, losing, however, the specificity of the diagnosis. The actual possibility of dimensional diagnosis in DSM-V¹ is nonetheless a recognition of the difficulty of grouping syndromes that occur with individual psychopathological phenomena in every single case.

In the reported case, the diagnosis of paranoid schizophrenia has some peculiarities, as violence against animals and against people – presented by the patient before the onset of psychotic symptoms – are not characteristic of the schizophrenic syndrome, and are usually associated with antisocial personality disorders or psychopathy

However, Kahlbaum described in 1885², pre-schizophrenic symptoms characterized by oppositional behavior to family and society, with possible outbreaks of violence similar to those presented by psychopaths. The hebephrenia as the author titled, mimicking the psychopathy. But different from what occurs in disorders of personality, the evolution is compatible with a diagnosis of schizophrenia, with positive and negative symptoms present.

The recognition of this psychopathological description has importance not only in the performance of forensic psychiatrists, but also in everyday psychiatric clinic. The neglect of classical psychopathology in outpatient psychiatry can lead psychiatrists to remain restricted to the use of standardized scales and superficial behavior analysis, leaving to observe these nuances psychopathological.

The case described³ is typical for those who work as a forensic psychiatrist, and is fruitful for reflection of the complex relationship between mental illness and violence. Moreover, his account is a singular testimony of psychopathological wealth and biographical poverty that is still present in the custody and treatment hospitals in Brazil.

References

• ¹
  American Psychiatric Association (APA). DSM-V – Manual Diagnóstico e Estatístico de Transtornos Mentais. 5th ed. rev. Porto Alegre: Artmed; 2014.
• ²
  Ey H, Bernard P, Brisset C. Manual de psiquiatria. Rio de Janeiro: Ed Masson do Brasil Ltda.; 1981.
• ³
  Moscatello R. Patricide and schizophrenia – A case report. Arch Clin Psychiatry. 2014;41(6):159.

Comentários sobre a carta para o editor

Parricídio e esquizofrenia – Relato de caso Comments about letter to the editor

Gustavo Bonini Castellana

O crime de parricídio, assim como outros atos violentos, nem sempre está associado a transtornos mentais. Quando existe essa correlação, esta se dá principalmente com os transtornos psicóticos.

Entre as grandes síndromes psicóticas, a esquizofrenia é considerada a mais importante, tanto pela prevalência quanto pela cronicidade dos sintomas. Outros quadros psicóticos, como os transtornos delirantes persistentes e os transtornos psicóticos agudos, têm menor associação com crimes violentos, ainda que suas prevalências sejam relevantes na população comum.

As classificações psiquiátricas mais recentes tendem a agrupar os diagnósticos em grandes categorias. Tais agrupamentos têm como objetivo aumentar a confiabilidade entre os psiquiatras, perdendo, no entanto, a especificidade do diagnóstico. A atual possibilidade do diagnóstico dimensional presente no DSM-V¹ não deixa de ser um reconhecimento da dificuldade de agrupar síndromes que cursam com fenômenos psicopatológicos singulares em cada caso isolado.

No caso relatado, o diagnóstico de esquizofrenia paranoide apresenta algumas particularidades, já que a violência contra animais e contra pessoas – apresentada pelo paciente antes do surgimento dos sintomas psicóticos – não é característica da síndrome esquizofrênica e está normalmente associada a transtornos de personalidade antissocial ou psicopatia.

No entanto, Kahlbaum descreveu, em 1885², sintomas pré-esquizofrênicos caracterizados por comportamento de oposição à família e à sociedade, com possíveis episódios de violência, semelhantes aos apresentados por psicopatas. A hebefrenia, conforme intitulou o autor, mimetiza a psicopatia, mas diferentemente do que ocorre nos transtornos da personalidade, tem evolução compatível com o diagnóstico de esquizofrenia, com sintomas positivos e negativos presentes.

O reconhecimento dessa descrição psicopatológica tem importância não só na atuação de psiquiatras forenses, mas também na clínica psiquiátrica cotidiana. A negligência com a psicopatologia clássica nos ambulatórios de psiquiatria pode levar os psiquiatras a se restringir ao uso de escalas padronizadas e análises superficiais de comportamento, deixando de observar essas nuances psicopatológicas.

O caso descrito³, sendo típico para quem atua como psiquiatra forense, é profícuo para a reflexão da relação complexa entre doença mental e violência. Além disso, seu relato é um testemunho singular da riqueza psicopatológica que contrasta com a pobreza biográfica que ainda se encontra, infelizmente, na população internada dos hospitais de custódia e tratamento no Brasil.

Publication Dates

• Publication in this collection
  2014